Provider Demographics
NPI:1962570887
Name:RUDZINSKI, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RUDZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 HILLSBORO DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3126
Mailing Address - Country:US
Mailing Address - Phone:202-744-7618
Mailing Address - Fax:301-754-1305
Practice Address - Street 1:226 HILLSBORO DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3126
Practice Address - Country:US
Practice Address - Phone:202-744-7618
Practice Address - Fax:301-754-1305
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10393OtherCLINICAL SOCIAL WORKER